The Secretary’s review was conducted in conjunction with the Department of Behavioral Health and Developmental Services and included reviews of pertinent medical records and interviews with clinicians, hospital personnel, and law enforcement personnel involved in the events of November 18, 2013.

As a result of his review, Secretary Hazel developed recommendations to the governor that would further improve Virginia’s mental health system. These recommendations come in addition to McDonnell’s recent budget announcement that he was proposing $38.3 million in additional mental health spending over the biennium to expand critical mental healthcrisis services and for ongoing treatment and support services to help prevent crises from developing.

In addition, McDonnell signed Executive Order 68 that creates the Task Force on Improving Mental Health Services and Crisis Response. The executive order calls for leaders in the mental health field, law enforcement, the court system, the private hospitals, and individuals receiving services and their families to seek and recommend solutions that will improve Virginia’s mental health services system.

A copy of the letter from Secretary Hazel to McDonnell is available here.

Based on his review of the tragedy in Bath County, the Secretary’s recommendations for improving Virginia’s mental health system include:

Civil Commitment Process

· Amend Virginia Code § 37.2-808 to clarify responsibility for notifying the community services board (CSB) 1) when an ECO has been issued by the magistrate, 2) when the ECO has been executed by law enforcement and 3) of the location to which the individual has been taken for the preadmission screening assessment.

· Clarify through education of CSBs and willing hospitals that preadmission screening can be carried out electronically pursuant to § 37.2-809(B) and provide funding to assure that all CSBs have adequate and appropriate equipment to perform electronic screenings.

· Amend Virginia Code § 37.2-808(G) and (J) to provide an option for further extending the ECO period beyond six hours when the CSB clinician has determined that the individual meets the criteria for a TDO and additional time is needed to locate an available bed at a willing facility.

· Consider removing the requirement that the facility of temporary detention be specified on the Temporary Detention Order (TDO).

· Conduct a study to assess the need statewide for secure assessment sites and establish these sites in communities across the state as indicated by the study.

Facility of Temporary Detention

· Complete the implementation of the electronic psychiatric bed registry that is currently under development. Develop guidelines with the involvement of the CSBs and private hospitals to help assure that the database is maintained to reflect real time accuracy of available beds.

· Explore other technological capacities such as video conferencing and electronic exchanges of information that may improve the processes of finding and documenting resource availability in crises.

· Complete and implement revised guidelines for medical screening for use by private and state psychiatric hospitals and emergency departments.

· Clarify and assure more consistent and widespread awareness of the procedures for when the state hospital in the region should be contacted to secure a bed for the TDO and what prerequisites the CSB must meet before contacting the state hospital.

· Clarify when it is appropriate for a state hospital to be utilized for temporary detention and process for requesting and accessing such a bed.

· Clarify the role and expectations of crisis stabilization programs related to accepting individuals under temporary detention.

Creation of Adequate Service Capacity

· Expand the availability and capacity of services within the full crisis services response continuum in order to provide more effective alternatives to hospitalization in crises and to provide access to inpatient services when this is the most appropriate response.

· Conduct a study to determine the needs in each region of the state for services that will enable assessment and early identification of emotional and psychiatric concerns for children and adults, the provision of ongoing treatment and supports for children, adults and their families that will help maintain stability and functionality in their communities and thereby reduce the frequency and intensity of psychiatric crises.

· Assure continued and increased efforts to provide assistance to enable persons who no longer require inpatient services to be discharged from hospitals, thereby freeing up hospital resources for additional persons needing inpatient level of services.

Other

· Explore all avenues to increase and improve cooperation and mutual support through the partnerships between CSBS, state hospitals, private hospitals, law enforcement and judicial officials.

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